Purpose of the study: Wolff-Parkinson-White (WPW) syndrome is characterized by a wide spectrum of clinical conditions: many subjects remain asymptomatic  during the whole life, others suffer from paroxysmal episodes of atrioventricular tachycardia.
In case report, a sudden cardiac arrest was introduced in a patient  with undiagnosed WPW who underwent bilateral  thoracic sympathectomy  due to  hyperhidrosis
Materyal and Methods:
Endoscopic thoracic sympathectomy was performed in a 19-year-old healthy young patient for axillary hyperhidrosis. No problem was  occured during the surgery under general anesthesia.Before  the endotracheal extubation, a polymorphic ventricular tachycardia developed and diagnosis of WPW was detected with typical ECG findings. Amiodarone  infusion was  started and the extubation was abandoned. Meanwhile, ventricular fibrillation occured and cardiopulmonary resusitation was initiated. according to the recommendations of the ERC guidelines .In 30 minutes, Return of spontaneous circulation was performed in the patient. He underwent percutaneous coronary invertention but no coronary artery pathology was detected. Unfortunately Ejection fraction was lower(EF<20) The patient iwas mmediately  reoperated and the sympathectomy clips were removed bilaterally. Then  arrhythmia decreased but hypotension continued. After 4 hours,  consciousness of the patint returned but He died of  cardiopulmonary shock in 48 hours.In postmortem investigation,the patient's family history revealed heart disease that was not mentioned in the preoperative evaluation. The patient’s familt also remember that he had some syncopes which was never investigated during his childhood
Result:  
WPW can be a life-threatening arrhythmia by deterioration into ventricular fibrillation. Decrease in the sympathetic effect on the heart with a surgery in a patient with probable cardiac transmission problems may increase the possibility of  peri arrest arytmia such as WPW
Conclusion 
There is no obvious structural heart disease, it is possible that some of these individuals died because of a cardiac arrhythmia
References
Am Coll Cardiol 2004;43:1137
Medicine 2018 ; 97(51): e13248

5 - A case of sudden cardiac arrest due to Wolf Parkinson White Sydrome